People Behind BCSS: Rosemary's Story
We all know how BCSS helps families find support. We all know that BCSS is there when people need them. But who are the people who make BCSS what...
This document provides an overview of the BC Mental Health Act relevant for families and others concerned about a person with mental illness.
The BC Mental Health Act exists to help someone with an apparent serious mental illness who refuses to obtain necessary treatment. Families should encourage their loved one to obtain treatment voluntarily. (There are other helpful documents and resources that may be helpful in encouraging voluntary treatment on http://www.bcss.org)
However, with some illnesses the person cannot be persuaded to accept treatment voluntarily. The only alternative is involuntary admission and treatment under the BC Mental Health Act. Families often play a crucial role in facilitating this.
The following issues are addressed:
Early on you should speak with someone knowledgeable about the MHA. Local BCSS Regional Educators will often be able to help or refer you appropriately. (Find one near you). Other resources include:
If a person cannot be admitted as a voluntary patient, the person can only be involuntarily admitted if a physician finds that the person meets all the following 4 criteria (section 22 MHA) listed on FORM 4 from the Guide to the Mental Health Act (2005).
1. Definition of Mental Disorder: “disorder of the mind that requires treatment and seriously impairs the person’s ability (a) to react appropriately to the person’s environment, or (b) to associate with others”) AND
2. Deterioration OR harm criterion: The person “requires care, supervision and control in or through a designated facility to prevent the person’s or patient’s substantial mental or physical deterioration or for the protection of the person or patient or the protection of others” AND
3. Requires psychiatric treatment: “requires [psychiatric] treatment in or through a designated facility” AND
4. Is not suitable as a voluntary patient.
If a person is still unwilling to voluntarily be examined, there are three options for obtaining involuntary admission. We advise attempting them in the following order (if possible): Appeal directly to a physician; Request police assistance; Obtain an order from a judge or justice of the peace.
When admission to a psychiatric unit is being considered, families can provide important collateral information to the physician, police officer, or judge involved.
It helps to use the following headings to make notes of symptoms and behaviours as they happen:
a) Mental Disorder – Hallucinations, delusions, depression, irrational thoughts,
b) Prevention of substantial mental or physical deterioration – Previous episode(s) and now similar symptoms recurring or developing. (i.e. non-adherence to medication or treatments, not eating)
c) Need for protection of self or others – Threats, paranoid delusions, deteriorating physical condition, irrational wasting of money, likelihood of losing job or family, suicidal thoughts or gestures.
d) Need for psychiatric treatment – Previous diagnosis and treatment. Current symptoms noted in (a) may also indicate a need for psychiatric re-assessment.
e) Unwillingness to accept voluntary treatment – You and/or others have tried to persuade the person to see a physician for examination and assessment but were unsuccessful.
Note: In a crisis situation, you may want to also seek advice or observations from a mental health clinic, family doctor, hospital psychiatric unit, police, urgent care teams, etc.
A person who does not meet admission criteria must be discharged. However, discharging physicians must consider whether “there is a significant risk that the patient, if discharged, will as a result of the mental disorder fail to follow the treatment plan…necessary to minimize the possibility that the patient will again be detained under section 22”. The person discharged from involuntary status can continue as a voluntary patient if the physician agrees.
Review Panel Discharge
A review panel uses the same criteria as a discharging physician.
Extended Leave (compulsory community treatment)
“Extended Leave” is available under the BC Mental Health Act and can help people adhere to their treatment plan in the community.
Section 37 of the Act states: “…if the director considers that leave would benefit a patient detained in a designated facility, the director may release the patient from the designated facility providing appropriate support exists in the community to meet the conditions of the leave.”
The patient must continue to meet admission criteria, with renewals examinations following the same time periods as for inpatients. Responsibility for certificates can be delegated to community physicians who are part of a community mental health team.
If ‘Extended Leave’ conditions are broken, the patient returns to hospital.
Family’s role: Families can recommend to an authorizing physician that a patient be put on extended leave, especially if relapses recur due to not taking medication. Families can also provide information regarding the particular conditions of extended leave, and may participate in monitoring medication and compliance with other conditions (e.g., safe, stable residence, regular physician care, etc.)
If a patient wants to be discharged from hospital or from extended leave against their physician’s advice, the patient (or anyone else acting on the patient’s behalf) can appeal to a Review Panel. If the appeal is successful, the patient must be released.
A Review Panel includes a lawyer, a physician, and a person who is neither. All are independent of the hospital. Patients and their near relative are informed of their right to a Review Panel hearing on admission.
Family’s role. Detail on how families can be involved with a Review Panel hearing if they oppose the desire of the patient to be released can be found on the Review Board website at https://www.bcmhrb.ca/
If a patient appeals to the Review Panel, the near relative (often a family member) is informed of the date of the hearing. Family members who want to provide information in support of further detention of the patient must contact the attending physician. https://www.bcmhrb.ca/i-am-family-or-a-support-person-for-a-patient/
In addition to providing information relevant to involuntary admission, a family member may have important information for the Review Panel. Section. 25(2.1) of the Mental Health Act states: “A hearing by a review panel must include:
(a) consideration of all reasonably available evidence concerning the patient’s history of mental disorder including (i) hospitalization for treatment, and (ii) compliance with treatment plans following hospitalization, and
(b) an assessment of whether there is a substantial risk that the discharged patient will as a result of the mental disorder fail to follow the treatment plan the director or a physician authorized by the director considers necessary to minimize the possibility that the patient will again be detained under section 22. [the admission criteria]”
The “near relative” receives notice of admission, review panel application, discharge, and rights. They may exercise rights on person’s behalf for the following:
Family members often have knowledge about the patient that would be helpful for clinicians responsible for admission, treatment plans, or discharge planning. Conversely, family members often need information from the medical team because the family is usually involved with supporting the person after discharge. If a patient consents to this information exchange, the clinician has authority to comply.
Sometimes a clinician will not provide information because the patient has not given specific consent. However, the Freedom of Information and Protection of Privacy Act allows for the following: “Public bodies [clinicians] may release necessary personal information to third parties without the consent of the client where disclosure is required for continuity of care or for compelling reasons if someone’s health or safety is at risk” (See Guide to the Mental Health Act, page 119, and BC Schizophrenia Society policy paper, Obtaining and Providing Mental Health Information to Families. (1)
Family’s role. Some clinicians believe that “patient confidentiality” is absolute. They are unaware of important exceptions pertaining to the Freedom of Information and Protection of Privacy Act. Reference to Appendix 13 (p.119 of the Guide) can help physicians better understand these important legal exceptions. When everyone has the facts, essential information can flow both ways—allowing clinicians and families to work together to provide the best possible care and support for the patient.
(1) The MHA refers to a Near Relative who receives rights and other information. A patient can appoint anyone as a “near relative” including non-relatives. If no one is appointed by the patient, a person may be appointed by the physician from a list of relatives (see Guide, page 176). Thus it is possible that the closest relative (e.g. wife or husband) may not be appointed as the “near relative” by the patient even though that person is also the caregiver. The Guide points out that the physician may send notices to a family member, even though not appointed as a near relative.